State Senators Float Plan to Drop Out of Medicaid

Top Florida senators said Monday the state should consider dropping out of the federal-state Medicaid program to avoid a planned expansion and create its own health care system for low-income residents.

Sens. Mike Haridopolos, R-Melbourne, and Don Gaetz, R-Niceville, told the News Service of Florida they will advance plans to seek a federal waiver that would allow the Florida to retain the $18.2 billion in state and federal funding needed to finance the program next year, but without the strings typically attached by Washington.

The two lawmakers said they want authority to create a Florida program outside federal regulations contained in the recently approved House health-care overhaul, which they warned could expand by 1 million the number of Floridians qualifying for Medicaid.

“We are looking at a Medicaid program that already has metastasized in this state, with 600,000 new enrollees over the past 20 months as a result of the economy,” said Gaetz, chairman of the Senate’s Health Regulation Committee. “To significantly expand the program on top of that, would have serious consequences for Florida.”

Haridopolos and Gaetz spent Monday in Washington, D.C., being briefed on federal health care legislation by organizations including the Heritage Foundation and U.S. Chamber of Commerce.

Gaetz insisted that the call for a Florida-only program was not a product of having consumed “Republican or conservative Kool-Aid in Washington.”

Instead, “you have to realize that every time Medicaid has expanded, it has had a severe impact on Florida taxpayers,” Gaetz said.

The U.S. House legislation would allow individuals with incomes up to 150 percent of the federal poverty level ($33,075 for a family of four) to qualify for Medicaid. The federal government would pay the costs for those newly eligible for the first two years and 91 percent of the costs after that.

The U.S. Senate is considering a more modest Medicaid expansion – allowing income-levels of as much as 133 percent of poverty to qualify. Medicaid currently covers nearly 2.7 million Floridians – a level state officials say is expected to climb by at least 5 percent next year.

Haridopolos, in line to become Senate president following next fall’s elections, fears that a federal Medicaid expansion will blow up in his lap once he becomes a leader. Gaetz, in turn, is angling to succeed Haridopolos as Senate president and clearly is wary of a Medicaid program already running a $225 million shortfall this year.

“Everyone agrees that the current Medicaid system is broken,” Haridopolos said. “Why would we want to expand on this system. Instead, we’re saying to the federal government: ‘Give us the $18 billion. Lock in a dollar number. And we’ll create a Florida market.”

But advocates for the program dismiss the senators’ stance, saying their fear of excessive spending is fueled by lobbying organizations steadily criticizing federal reform efforts.

Also, Florida’s history of trying to craft its own social welfare programs is poor.

A five-county Medicaid experiment – aimed at steering more low-income Floridians to less-expensive HMOs and other managed care operations – was expected to expand steadily after launching in 2005, leading into the final year of Gov. Jeb Bush’s administration.,

Instead, the Republican-led Legislature has stalled the program largely because cost-savings never emerged, said Greg Mellowe, policy director for Florida CHAIN, a health care consumer advocacy organization.

“Under the House plan, the state will only have to start paying 9 cents on the dollar beginning in 2015, two years after the program starts,” Mellowe said. “I don’t think the state could do anything like what is being proposed at a cheaper rate.”

Similarly, a federal judge last month also set a Dec. 7 trial for a class-action lawsuit filed in 2005 by the Florida Pediatric Society and Florida Academy of Pediatric Dentistry, which claims the state has failed to meet federal requirements that low-income children receive periodic health screening and routine dental checkups.

The medical groups maintain that 200,000 children eligible for Medicaid receive no benefits because Florida officials have failed to use effective outreach programs. Another 1.5 million children enrolled don’t receive the kind of coverage mandated by the federal government, the lawsuit contends.

Sen. Nan Rich, D-Weston, vice-chairman of the Senate’s Health and Human Services budget committee, also called the Gaetz-Haridopolos approach a “non-starter.”

“We don’t have a very good track record with running our own programs,” Rich said. “The only way we seem to be able to do it cheaper is to cover fewer people and offer fewer benefits. And that’s not a direction I want to see us go.”